The Phia Group has been beyond thrilled with our talented, dedicated members who have come to us through Year Up. Sheyla and Josh have become such essential members of our team – we feel truly blessed to call them a part of the Phia Family. We sat down with them to hear their thoughts and experiences:

Q: How did you hear about Year Up?

Sheyla: I was discussing my job situation with friends and family. I was working long hours with little pay in a pizza shop; I felt stuck. They suggested I apply for Year Up.

Josh: I was working at a full service gas station. The pay was bad, the environment was rough, and I was over it. My dad actually told me about Year Up – He said they put you on a good path and you could make money while in the program.

Q: How was getting your foot in the door?

Sheyla: It’s kind of tough to get in the program; they don’t take everyone – it was competitive. The seats fill up fast. I was 21 when I joined the program.

Josh: I had friends already go through the program. The application process is time sensitive, someone could finish their paperwork before you and they would get in and you wouldn’t. I was 24 when I started.

Q: Did you choose Phia or was Phia chosen for you?

Sheyla: Phia was chosen for me; we didn’t really interview, after we knew we’d be going to Phia we met with our director and a couple people from Phia just to have a conversation.

Josh: I looked up Phia and I didn’t have a real grasp on what they did, I was asking a lot of people things like ‘what’s subrogation?’ - There were a lot of things I’d never heard of before.

Q: What was it like when you first started at The Phia Group?

Sheyla: I kept thinking to myself ‘am I doing this right? Do I shake everyone’s hands?’ – Year Up did a good job of preparing me with a general skill set but getting comfortable with Claim Analysis was tough coming from only having experiences in finance.

Josh: Everyone speaks so highly of Sheyla, she does a great job. I actually started working in a bunch of different departments, moving around from task to task to get a hold of what I fit best in. I did a lot in IT and Claim Analysis and eventually found my place in coding.

Q: What skills have you gained through Year Up and The Phia Group?

Sheyla: Actually working on a computer is something I’ve grown a lot in. I wasn’t familiar with Claim Analysis when I got here and I was able to learn new skills and grow within the department. I was also able to change my perspective on team work. In the past I would take the bulk of the work when working in groups, I would be the one to carry the team through the project. I got a stronger sense of the idea of team work when I came here. It is balanced, people pull their own weight, and it’s nice to see that. People are nice here, it feels good not to have to carry people, it’s nice to have a great team.

Josh: I feel I’ve gained a lot of computer skills. I know Excel really well now, I’m proud of that. Learning how to code is also something I’m proud of, I would like to grow more with my coding skills. When I first came in they didn’t really know where to place me, I got my feet wet in all different departments, and I’m happy I ended up where I am. I learned slowly about what every department does here, I’m grateful for the growth process.

Q: Where did you see yourself in 5 years before Year Up?

Sheyla: I got into The AI in Brookline but I had payments due and I couldn’t find a job to pay for school. I had to drop out. From there I worked small jobs and I wanted to save up money to go to school.

Josh: I wanted to be a chef and I had dreams of owning a food truck. I dropped out of art school with no way to pay for it.

Q: Where do you see yourself in 5 years now?

Sheyla: I’d like to still be working at The Phia Group – I like what I do here and I feel like I have a leg up in this field with all that I’ve learned and the experience I’ve gained.

Josh: With my background in coding, I want to take it further. I see how great a coding career is and I want to get better at it; I’d like to follow in the steps of some of the execs here.

Q: What advice would you give to others in Year Up?

Sheyla: Year Up gives people an opportunity to have a meaningful career. If you’re going to do it, make sure you’re fully invested in it. I do wish Year Up was offered in more places, it’s a great program.

Josh: It’s not easy so don’t slack off, follow the rules and commit to it. At first I was scared I wouldn’t be able to work in an office environment; Year Up gives you the skills and professionalism to succeed.

We would like to thank Sheyla and Josh for taking the time to tell us about their experiences.

Employers who self-fund their health plan act as a traditional employer, a plan sponsor, and a plan administrator. Juggling this many roles, conflicts and contradictions are bound to happen. For instance, an  employee handbook’s handling of disability leave may conflict with the health plan document as it relates to employment and plan coverage.

Thanks for joining The Phia Group’s legal team on February 15, 2017, as they discussed top miscues employers make when it comes to their health  plans, and what we all can do to become health plan heroes; rescuing employers who have blurred the lines, and will without our help soon be stuck between a rock and a hard place.

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The Phia Group, LLC Officially Announces the Release of its New “Independent Consultation & Evaluation” (ICE) Service

Braintree, MA – The Phia Group has for more than a decade been a source of document review, claim analysis, and regulatory compliance consultation for the health benefits industry. Today, statutory changes are occurring with greater frequency, and the industry needs objective analysis and expert consultation now more than ever before.

Unfortunately, hourly billing (the method by which most legal consultants charge clients) tends to be difficult to budget, predict, and afford. Rather than force clients to choose between dealing with open ended invoices and addressing difficult situations without assistance, The Phia Group now offers a consultation service featuring a per-employee per-month subscription fee.

“From business development and third party contract review to the application of ambiguous plan exclusions in unusual circumstances, you need legal consultation. To address regulatory compliance concerns, claim processing queries, and to collaborate on difficult administrative tasks, having an experienced team of attorneys and industry experts on call is a must have,” remarked The Phia Group’s CEO, Adam V. Russo, “The Phia Group understands, however, that the cost can be prohibitive – until now.”

The Phia Group’s Senior Vice President and General Counsel, Ron E. Peck, remarked, “We believe that we are all ethically obligated to seek out objective, professional feedback in response to difficult situations. When the cost of such aid increases as the time spent on the matter extends, those who bill by the hour are rewarded for delays, and clients are punished for seeking out thorough review. The Phia Group opposes that inherent conflict of interest.”

With an ICE subscription fee, clients can preemptively budget for and share the cost of this invaluable resource – allowing The Phia Group and their clients to focus on what is really important – results.

For more information regarding ICE and The Phia Group’s many other services, please contact The Phia Group’s Sales Executive, Garrick Hunt, by email at ghunt@phiagroup.com or by phone at 781-535-5644.

Our industry is plagued by issues related to compliance, contracts, and cost-containment – and a myriad of other legal issues as well. Engaging an expert for a second set of eyes is a chore in itself, requiring approval from management or an individual group as well as a cost-benefit analysis of the expert’s fees – sometimes resulting in the decision not to consult a neutral third-party at all.

The Phia Group has been providing consulting services since its inception seventeen years ago. We have seen thousands of problems that could have been mitigated or avoided entirely by consulting an expert. As a result, we have created the ICE service – short for Independent Consultation and Evaluation.

Thank you for joining The Phia Group’s legal team on September 22, 2016 at 1:00pm (EST) as they discussed some of the problems facing the self-funded industry today, provided examples of situations where being proactive rather than reactive would have been beneficial, and presented the value that ICE can hold for TPAs and health plans.

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Wrap networks provide plans with discounts off billed charges for claims that don’t fall within the plan’s primary network. But do these wraps really add value? With skyrocketing provider charges and static discounts off of those charges, the modern-day wrap network doesn’t seem to provide much help when it comes to claims costs.

Thank you for joining The Phia Group’s legal team on August 23rd, as we analyzed provisions of wrap network agreements, with a focus on what plans can or can’t do to cut costs. We proposed some innovative ways for your plans to save additional money above and beyond wrap networks, generating unprecedented value for your plans.

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The self-funded industry is made up of a complex system of contracts, and navigation across them is anything but simple. Network contracts supersede plan documents; Administrative Services Agreements “add” plan provisions, stop-loss policies embrace carve-outs but networks prohibit them, employee handbooks promise benefits not provided by the SPD…and those are just a few examples of areas of confusion.

Thank you for joining The Phia Group on May 12th, 2016 as its legal team gave a crash course in contracts. Cost-containment can be impacted by the contracts you sign, and there are often exceptions and restrictions buried deep down, or potential issues not considered beforehand. In this webinar, The Phia Group explained some of the contracting pitfalls experienced on a daily basis within the self-funded industry.

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